滤泡性淋巴瘤的分级：常规组织学与免疫组织化学的比较

Grading of follicular lymphoma: comparison of routine histology with immunohistochemistry.

作者信息

Martinez Antonio E, Lin Li, Dunphy Cherie H

机构信息

Division of Hematopathology, Department of Pathology and Laboratory Medicine, Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7525, USA.

出版信息

Arch Pathol Lab Med. 2007 Jul;131(7):1084-8. doi: 10.5858/2007-131-1084-GOFLCO.

DOI:10.5858/2007-131-1084-GOFLCO

PMID:17616995

Abstract

CONTEXT

Follicular lymphoma (FL) grading is based on the average number of large transformed cells in 10 neoplastic follicles at x40 high-power field (x10-40 high-power field) examination (grade 1, 0-5 centroblasts per high-power field; grade 2, 6-15 centroblasts per high-power field; grade 3, >15 centroblasts per high-power field).

OBJECTIVE

Since there may be significant interobserver variability, we analyzed the usefulness of immunohistochemical stains in grading FLs more reliably.

DESIGN

Forty-three FLs initially graded by World Health Organization criteria (grade 1, 12; grade 2, 18; grade 3, 13) were reviewed and stained with CD3, CD20, Ki-67, CD30, CD68, PAX-5, and BCL-6. Retrospective review was performed for the average number of large cells, of large lymphoid cells, of large cells staining with CD3, CD20, BCL-6 (40 cases), and PAX-5, and of all cells staining with CD68, Ki-67, and CD30.

RESULTS

By histologic review, 8 of 43 FLs had a significant grade change (4 cases upgraded and 4 cases downgraded). CD3 and CD30 stained only 0 to 3 large cells and 0 to 3 cells, respectively, in neoplastic follicles. CD68+ cells represented the large nonlymphoid cells. Increasing FL grades demonstrated increases in Ki-67+ cells. The original grade showed substantial agreement with CD20 and moderate agreement with PAX-5 and BCL-6. The original histologic grade agreed with immunohistochemical-based grade using 2 or more antibodies in 5 of 8 discordant cases (4 by CD20 or BCL-6 and PAX-5; 1 by CD20, PAX-5, and BCL-6).

CONCLUSIONS

Interobserver variability of histologic FL grading may be significant; we showed low-end "substantial agreement." Immunohistochemical stains (ie, CD20, PAX-5, and BCL-6) may more reliably determine the number of large transformed cells in neoplastic follicles; Ki-67 staining correlates with higher FL grades. Immunohistochemical stains may be evaluated in clinical trials of FL patients to determine prognostic significance.

摘要

背景

滤泡性淋巴瘤（FL）分级是基于在40倍高倍视野（10 - 40倍高倍视野）下10个肿瘤滤泡中大型转化细胞的平均数量（1级，每个高倍视野0 - 5个中心母细胞；2级，每个高倍视野6 - 15个中心母细胞；3级，每个高倍视野＞15个中心母细胞）。

目的

由于观察者之间可能存在显著差异，我们分析了免疫组织化学染色在更可靠地对FL进行分级方面的实用性。

设计

回顾了43例最初按照世界卫生组织标准分级的FL（1级，12例；2级，18例；3级，13例），并用CD3、CD20、Ki - 67、CD30、CD68、PAX - 5和BCL - 6进行染色。对大型细胞、大型淋巴细胞、用CD3、CD20、BCL - 6（40例）和PAX - 5染色的大型细胞以及用CD68、Ki - 67和CD30染色的所有细胞的平均数量进行回顾性分析。

结果

通过组织学检查，43例FL中有8例有显著的分级变化（4例升级，4例降级）。CD3和CD30分别仅对肿瘤滤泡中的0至3个大型细胞和0至3个细胞进行染色。CD68 +细胞代表大型非淋巴细胞。FL分级增加表明Ki - 67 +细胞增加。原始分级与CD20显示出高度一致性，与PAX - 5和BCL - 6显示出中度一致性。在8例分级不一致的病例中，有5例原始组织学分级与基于免疫组织化学的分级一致（4例通过CD20或BCL - 6和PAX - 5；1例通过CD20、PAX - 5和BCL - 6）。